Distal femur fractures are severe knee injuries that threaten the viability of the limb.
When the fractures are not displaced, nonsurgical treatment may be an option.
Most supracondylar femur fractures are treated with surgery in order to decrease the odds of deformity and stiffness.
Most distal femur fractures are treated by plating the fracture laterally. The approach is safe, fairly routine, but the incision can be very large.
The broken fragments of bone are realigned by placing traction on the foot, and by using various clamps and temporary wires. The plate is then placed adjacent to the fracture, and screws are placed above and below the fracture.
For certain fracture patterns, it may be possible to reduce and stabilize the condyles with several screws, and then to stabilize the reconstructed condyle block to the shaft with an intramedullary nail.
This was an intraarticular OTA C3 closed fracture. The entire articular surface is involved. Notice the presence of three condylar lines in the lateral view. Since a knee only has two condyles, this finding indicates a split in the sagital plane of one of them.
The extent of comminution can best be appreciated by looking at the CT slices. The CT confirms the sagital plane fracture of one of the condyles (the medial condyle in the left of the axial section).
Standard lateral approach was carried out, anterior to the intermuscular septum, followed by painstaking reconstruction of the distal femoral articular surface. The condylar reconstructed fragment was held together intraoperatively with multiple K-wires, which were then removed after insertion of the permanent implants.
These are xrays done after the surgery, with alignment restored.
Physical therapy was immediate and vigorous, albeit without allowing weight bearing.
Following are xrays done at 3 months after surgery. There is some loss of alignment, but the patient was pain free, bearing weight, and motion of the knee was fluid, despite his preexisting arthritic disease.
Additional degenerative changes are possible, and his arthritis may worsen in the future. A knee replacement may be necessary. However goals of treatment of the fracture have been achieved: namely a pain-free, stable knee with good alignment.